Fill and Sign the Injury Release Form

Release By Individual From Responsibility for Participation in Inherently Dangerous Activity Release executed on ___________________ (date) , by ______________________ (name) of ____________________________________________ (street address, city, county, state, zip code) herein referred to as Releasor, in favor of ______________________________________ (organization or business) , of ____________________________________________ (street address, city, county, state, zip code) herein referred to as Releasee. In consideration of being permitted to participate in _____________________________ ____________________________________________ (insert nature of dangerous activity, such as: racing events or skydiving) or as the case may conducted by Releasee, Releasor, for himself his spouse, legal representatives, heirs and assigns, hereby releases, waives and discharges Releasee, its ____________________________________________ (e.g., officers and members, promoters, sponsors, advertisers, owners and lessees of the premises) and each of them, their officers and employees, herein referred to as Releasees, from all liability to the Releasor, his spouse, legal representatives, heirs and assigns, for any and all loss or damage, and any claim or damages resulting therefrom, on account of injury to Releasor = s person or property, even injury resulting in death of the Releasor, whether caused by the negligence of Releasees or otherwise while the Releasor is ____________________________________________ (e.g., competing, working or for any purpose participating) in (name of activity) . Releasor agrees to indemnify the Releasees hold them harmless from any loss, liability, damage or cost they may incur due to the presence of Releasor in or upon ____________________________________________ (describe area in which activity will occur), whether caused by the negligence of the Releasees or otherwise. Releasor hereby assumes full responsibility for the risk of bodily injury, death or property damage due to the negligence of Releasees or otherwise while in or upon ____________________________________________ (describe area in which activity will occur), and while competing, officiating in, working or for any purpose participating in ____________________________________________ (name of activity). Releasor expressly agrees that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of _________________, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. In witness whereof, Releasor has executed this Release at ______________________ (designate place of execution) the day and year first above written. ______________________________ RELEASOR